Guthrie George E, Bogue Richard J
a University of Central Florida, Community Faculty, Loma Linda University-Preventive Medicine , Winter Park , Florida.
J Am Coll Nutr. 2015;34(4):300-9. doi: 10.1080/07315724.2014.933454. Epub 2015 Mar 11.
There is a growing awareness that lifestyle behavior modifications may reduce weight and the atherogenic dyslipidemia associated with obesity and type 2 diabetes mellitus (T2DM).
We pilot the effectiveness of a diabetes educational program combining shared medical appointments (SMAs) with an 8-week DVD-based diabetes education program emphasizing a plant-based diet in lowering weight and lipids in individuals with T2DM. This pilot also employed a nonrandomized convenience sample to explore which of the educational program's target behaviors were associated with the greatest risk factor reduction.
Forty-six adult patients with T2DM voluntarily self-selected to enroll in the educational quality improvement initiative run as part of a community clinical practice. Target behaviors measured weekly were (1) days with beans for breakfast, (2) days of exercise, (3) minutes of exercise per day, (4) days with light evening meals, (5) days with no evening meals, (6) days with no red meat, (7) days with plant-based diet, and (8) number of 8-ounce cups of water per day. Biometric measurements were taken at the beginning and end of the 2-month program. These included high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and triglycerides. Weight was measured weekly. Regression analysis was performed to identify which target behaviors were associated with changes in lipids and weight.
There was a statistically significant (F = 2.429; df = 8.21; p < 0.05) decrease in weight (mean -8.9 lbs, or 4.05 kg, or 4.1% body weight, p < 0.01) during the 8-week study period. There was a positive trend in all lipid parameters, but none reached statistical significance with this sample. Exploratory weighted least-squares regression found that weight loss in the study group was most associated with higher water consumption (t = 3.16; p < 0.01), days per week with no evening meal (t = 3.03; p < 0.01), and days per week consuming beans for breakfast (t = 2.06; p = 0.05.
In this pilot study, the DVD-based educational program delivered as part of an SMA was associated with significant weight loss but insignificant lipid changes. Behavior changes most closely associated with weight loss were increasing water consumption, eliminating evening meals, and increasing the consumption of beans for breakfast. These potentially important findings in this small sample suggest the need for a randomized clinical trial with a larger and planned sample.
人们越来越意识到，改变生活方式行为可能会减轻体重，并改善与肥胖和2型糖尿病（T2DM）相关的致动脉粥样硬化性血脂异常。
我们对一项糖尿病教育项目的效果进行试点，该项目将共享医疗预约（SMA）与一个为期8周的基于DVD的糖尿病教育项目相结合，该项目强调以植物性饮食为主，旨在降低T2DM患者的体重和血脂。该试点还采用了非随机便利样本，以探索该教育项目的哪些目标行为与最大程度降低风险因素相关。
46名成年T2DM患者自愿自我选择参加作为社区临床实践一部分开展的教育质量改进计划。每周测量的目标行为包括：（1）早餐吃豆类的天数；（2）锻炼天数；（3）每天锻炼的分钟数；（4）晚餐清淡的天数；（5）不吃晚餐的天数；（6）不吃红肉的天数；（7）以植物性饮食为主的天数；（8）每天饮用8盎司水杯的数量。在为期2个月的项目开始和结束时进行生物测量。这些测量指标包括高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、总胆固醇和甘油三酯。每周测量体重。进行回归分析以确定哪些目标行为与血脂和体重的变化相关。
在为期8周的研究期间，体重有统计学显著下降（F = 2.429；自由度 = 8.21；p < 0.05）（平均下降8.9磅，即4.05千克，或体重的4.1%，p < 0.01）。所有血脂参数均呈上升趋势，但在该样本中均未达到统计学显著性。探索性加权最小二乘回归发现，研究组的体重减轻与较高的饮水量（t = 3.16；p < 0.01）、每周不吃晚餐的天数（t = 3.03；p < 0.01）以及每周早餐吃豆类的天数（t = 2.06；p = 0.05）最为相关。
在这项试点研究中，作为SMA一部分提供的基于DVD的教育项目与显著的体重减轻相关，但血脂变化不显著。与体重减轻最密切相关的行为变化是增加饮水量、不吃晚餐以及增加早餐豆类的摄入量。这个小样本中的这些潜在重要发现表明需要进行一项有更大且经过规划的样本的随机临床试验。
